MEDICARE: MYO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	16776	KS

General Provider Information

NPI Number	:	1992997043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYO INC

Provider Business Mailing Address
First Line	:	6013 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1436
Country	:	US
Telephone Number	:	913-281-2090
Fax Number	:	913-788-9400

Provider Business Practice Location Address
First Line	:	6013 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1436
Country	:	US
Telephone Number	:	913-281-2090
Fax Number	:	913-788-9400

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. JOHN HAROLD HENDERSON
Credential	:	M.D.
Telephone Number	:	913-710-8440

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	09/20/2007

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